POSTTRAUMATIC STRESS DISORDER
DIAGNOSIS AND ASSESSMENT
of theTHE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract V101(93)P-2155 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, or conclusions expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
International Standard Book Number 0-309-10207-3
Additional copies of this report are available from the
National Academies Press,
500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624– 6242 or (202) 334–3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.
Copyright 2006 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J.Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm.A.Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V.Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J.Cicerone and Dr. Wm.A.Wulf are chair and vice chair, respectively, of the National Research Council.
SUBCOMMITTEE ON POSTTRAUMATIC STRESS DISORDER
RICHARD MAYEUX, MD, MS (Chair), Gertrude H.Sergievsky Professor of Neurology, Psychiatry, and Epidemiology, Director,
Sergievsky Center, and
Co-Director,
Taub Institute, College of Physicians and Surgeons, Columbia University
KATHRYN KARUSAITIS BASHAM, PhD, MSW, Professor,
Smith College School for Social Work
DENNIS S.CHARNEY, MD, Dean of Research and Anne and Joel Ehrenkranz Professor,
Departments of Psychiatry, Neuroscience, and Pharmacology and Biological Chemistry, Mount Sinai School of Medicine
MICHAEL DAVIS, PhD, Robert W.Woodruff Professor of Psychiatry, Behavioral Sciences and Psychology,
Emory University
DWIGHT L.EVANS, MD, Ruth Meltzer Professor and Chairman,
Department of Psychiatry, Medicine and Neuroscience, University of Pennsylvania School of Medicine
JACK GORMAN, MD, President and Psychiatrist-in-Chief,
McLean Hospital
JANICE L.KRUPNICK, PhD, Professor,
Department of Psychiatry, Georgetown University
BRUCE S.MCEWEN, PhD, Alfred E.Mirsky Professor and Head,
Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, Rockefeller University
CAROL S.NORTH, MD, MPE, Professor of Psychiatry and Nancy and Ray L.Hunt Chair in Crisis Psychiatry,
University of Texas Southwestern Medical Center Department of Psychiatry (resigned October 2005)
JERROLD F.ROSENBAUM, MD, Psychiatrist-in-Chief and Stanley Cobb Professor of Psychiatry,
Massachusetts General Hospital, Harvard Medical School
COMMITTEE ON GULF WAR AND HEALTH: PHYSIOLOGIC, PSYCHOLOGIC, AND PSYCHOSOCIAL EFFECTS OF DEPLOYMENT-RELATED STRESS
RICHARD MAYEUX, MD, MS (Chair), Gertrude H.Sergievsky Professor of Neurology, Psychiatry, and Epidemiology, Director,
Sergievsky Center, and
Co-Director,
Taub Institute, College of Physicians and Surgeons, Columbia University
JAMES C.ANTHONY, MS, PhD, Professor and Chair,
College of Human Medicine, Michigan State University (resigned March 2006)
KATHRYN KARUSAITIS BASHAM, PhD, MSW, Professor,
Smith College for Social Work
EVELYN J.BROMET, PhD, Professor,
Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook
GREGORY L.BURKE, MD, MS, Professor and Director,
Public Health Sciences, Wake Forest University School of Medicine
DENNIS S.CHARNEY, MD, Dean of Research and Anne and Joel Ehrenkranz Professor,
Departments of Psychiatry, Neuroscience, and Pharmacology and Biological Chemistry, Mount Sinai School of Medicine
MICHAEL DAVIS, PhD, Robert W.Woodruff Professor of Psychiatry Behavioral Sciences and Psychology,
Emory University
DOUGLAS A.DROSSMAN, MD, Professor of Medicine and Psychiatry and Co-Director,
University of North Carolina Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina School of Medicine
DWIGHT L.EVANS, MD, Ruth Meltzer Professor and Chairman,
Department of Psychiatry, Medicine, and Neuroscience, University of Pennsylvania School of Medicine
VINCENT J.FELITTI, MD, Physician and Founder,
Department of Preventive Medicine, Kaiser Permanente Medical Care Program, San Diego
JACK GORMAN, MD, President and Psychiatrist-in-Chief,
McLean Hospital
KERRY L.KNOX, PhD, Associate Professor,
University of Rochester School of Medicine
JANICE L.KRUPNICK, PhD, Professor,
Georgetown University
WILLIAM B.MALARKEY, MD, Professor of Internal Medicine and Molecular Virology, Immunology and Medical Genetics, and Director,
Clinical Research Center, Ohio State University
BRUCE S.MCEWEN, PhD, Alfred E.Mirsky Professor and Head,
Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, Rockefeller University
CAROL S.NORTH, MD, MPE, Professor of Psychiatry and Nancy and Ray L.Hunt Chair in Crisis Psychiatry,
University of Texas Southwestern Medical Center Department of Psychiatry (resigned October 2005)
THOMAS G.PICKERING, MD, DPhil, Professor of Medicine,
Department of Medicine, Columbia University
JERROLD F.ROSENBAUM, MD, Psychiatrist-in-Chief and Stanley Cobb Professor of Psychiatry,
Massachusetts General Hospital
BERNARD TIMOTHY WALSH, MD, William and Joy Ruane Professor of Pediatric Psychopharmacology,
Department of Psychiatry, Columbia University
STAFF
CAROLYN E.FULCO, MS, IOM Scholar, Senior Program Officer
ROBERTA WEDGE, MS, Senior Program Officer
SANDRA GOODBODY, MSW, Senior Program Officer
ROSE MARIE MARTINEZ, ScD, Director,
Board on Population Health and Public Health Practice
HOPE R.HARE, MA, Administrative Assistant
DEEPALI PATEL, Senior Program Associate
PETER JAMES, Research Associate
DAMIKA WEBB, Research Assistant
DAVID TOLLERUD, Project Assistant
NORMAN GROSSBLATT, Senior Editor
CONSULTANTS
MIRIAM DAVIS, PhD, Independant Medical Writer,
Silver Spring, Maryland
CAROL S.NORTH, MD, MPE, Professor of Psychiatry and Nancy and Ray L.Hunt Chair in Crisis Psychiatry,
University of Texas Southwestern Medical Center Department of Psychiatry (as of October 2005)
REVIEWERS
This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following for their review of this report:
MICHAEL ALEXANDER, MD, Professor of Neurology, Beth Israel Deaconess Medical Center
EDNA B.FOA, PhD, Professor and Director, Center for the Treatment and Study of Anxiety, University of Pennsylvania
JUDITH HERMAN, MD, Harvard Medical School, Victims of Violence Program, Cambridge Hospital
JOHN H.KRYSTAL, MD, Professor of Clinical Pharmacology, Yale University School of Medicine, VA Connecticut Healthcare System, Ribicoff Research Facilities, Connecticut Mental Health Center
BARBARA ROTHBAUM, PhD, Director, Trauma and Recovery Program, The Emory Clinic, and Professor, Department of Psychiatry and Behavioral Sciences, Emory University
DAVID SILBERSWEIG, MD, Department of Psychiatry, Weill Medical College of Cornell University
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by ELAINE L.LARSON, PhD, RN. Appointed by the National Research Council, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author committee and the institution.